Abstract W P329: Systemic Inflammatory Response Syndrome during Hospitalization for Intracerebral Hemorrhage Drives Poor Functional Outcome at Discharge

Abstract

Background and Purpose: Systemic Inflammatory Response Syndrome (SIRS) has been identified as a predictor of poor functional outcome at discharge in acute ischemic stroke patients treated with tPA. We sought to examine the relationship between SIRS and outcomes in patients presenting with primary intracerebral hemorrhage (ICH). Methods: A retrospective review of consecutive patients presenting to a tertiary care center from 2008-2013 with primary ICH was conducted. Demographic and clinical data were collected for analysis. Patients who were placed on comfort care or were diagnosed with an infection at any time were excluded. SIRS was defined according to standard criteria as having 2 or more of the following: (1) body temperature less than 36°C or greater than 38°C, (2) heart rate greater than 90, (3) respiratory rate greater than 20, or (4) white blood cell count less than 4000/mm or greater than 12,000/mm or more than 10% polymorphonuclear leukocytes for more than 24 hours. The outcomes of interest were discharge modified-Rankin Scale (mRS) of 4-6, death, and poor discharge disposition (discharge anywhere but home or inpatient rehab). Logistic regression models were used to evaluate the association between SIRS and outcomes before and after adjusting for ICH score. Results: A total of 249 ICH patients met inclusion criteria. Of these patients, 53 (21.3%) developed SIRS during their hospital stay. SIRS was associated with mRS 4-6 at discharge (OR 6.08, 95%CI 2.86-12.9, poor discharge disposition (OR 4.41, 95%CI 1.92-4.77) and death (OR 2.25, 95%CI 1.02-4.95). Adjusting for ICH score at baseline, SIRS remains associated with mRS 4-6 (OR 5.25, 95%CI 2.09-13.2) and poor discharge disposition (OR 3.74, 95%CI 1.58-4.83), but was no longer significantly associated with death (OR 1.75, 95%CI 0.58-5.32). Conclusions: SIRS occurred in 21% of patients with ICH. Even after adjusting for ICH score, patients with SIRS were at a 5 fold increased odds of having poor functional outcome at discharge. The high prevalence of SIRS, in addition to the increased risk of poor outcomes, necessitates further research to determine whether early intervention in treating SIRS will reduce the poor functional outcome seen in SIRS patients in the ICH population.